Surgery for Small Intestine Cancer (Adenocarcinoma)

Surgery is typically the main treatment for small intestine cancer. For some people, it might be the only treatment they need. At this time, surgery is the only treatment that can cure a cancer of the small intestine.

When might surgery be used?

• For people whose cancer is only in or near the place where it started (that is, in the small intestine and perhaps nearby organs), surgery is typically done to try to remove all of the cancer.
• If the cancer has spread too far to be removed completely, surgery might be done to help prevent or relieve problems that could be caused by the tumor growing large enough to block the intestine (or other problems).

The type of operation will depend on a number of factors, including the size and location of the tumor, and whether a person has any serious health problems.

Segmentectomy

This operation removes (resects) the segment of intestine that has the tumor, as well as some of the normal tissue on either side of the tumor. The 2 cut ends of the intestine are then attached back together. Some nearby tissue containing lymph nodes is also removed.

If the tumor is at the end of the ileum (the last part of the small intestine), the right side of the colon (the first part of the large intestine) might also be removed. This surgery is called a hemicolectomy.

Usually, a segmentectomy is done by making a long cut in the abdomen. Another option for some smaller cancers might be laparoscopic surgery, in which the operation is done through several small cuts using long, thin surgical tools.

After surgery, it can take a few days before you can eat and drink normally. Removing a small piece of intestine usually doesn’t cause long-term problems with eating or bowel movements, but there are more likely to be issues if part of the colon is removed as well.

Pancreaticoduodenectomy (Whipple procedure)

This extensive operation can be used to treat cancers of the duodenum (the first part of the small intestine), although it is more often used to treat pancreatic cancer. It removes the duodenum, part of the pancreas, part of the stomach, and nearby lymph nodes. The gallbladder and part of the common bile duct are also removed, and the remaining bile duct is then attached to the small intestine so that bile from the liver can continue to enter the small intestine.

This is a complex operation that carries a fairly high risk of complications, which can sometimes even be fatal. Because of this, it’s important to have it done by a surgeon (and at a center) with a lot of experience doing this procedure.

Still, even in the best hands, many people have side effects from this surgery. These can include:

• Leaking from where the organs were reconnected
• Infections
• Bleeding
• Trouble with the stomach emptying itself after eating
• Trouble digesting some foods
• Changes in bowel habits
• Significant weight loss

Palliative surgery

If the cancer can't be removed completely because it has spread too far, surgery might still be a good option to help prevent or relieve some symptoms from the cancer. This is known as palliative surgery.

Often, these operations are done to:

• Relieve a blocked intestine
• Decrease pain, nausea, and vomiting
• Help you to eat normally

If possible, the surgeon will remove enough of the tumor and nearby intestine to allow digested food to pass through.

Other options to relieve or prevent a blocked intestine:

Bypass surgery: The surgeon leaves the tumor in place and reroutes the healthy parts of the small intestine around the tumor.

Stent or tube placement: If major surgery isn’t a good option for some reason, sometimes an endoscope can be used to pass a tube (called a stent) down the digestive tract and into the blocked part of the intestine. The stent is left in place to help keep the intestine open and allow digested food to pass. If a stent cannot be placed, a thin, flexible tube may be placed through the skin and into the stomach to drain it. The tube can be left in place to help prevent problems with nausea and vomiting.